CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Echocardiographic screening detected PH in a relevant proportion of HIV-positive patients. PH and symptoms of right heart dysfunction were associated with higher mortality.

affects the extracardiac vascular system. Ascending aortic aneurysms are associated with increased risk for dissection and rupture. It is possible that increased inflammation resulting from HIV may increase the risk for dilatation. To date, no large studies have been conducted evaluating dilatation of the aortic root and ascending aorta in people with HIV. The aim of this study is to compare the prevalence and features of ascending aortic dilatation in men with HIV (HIV+) and without HIV (HIV-) in the Multicenter AIDS Cohort Study (MACS). Methods: 1179 MACS participants underwent complete echocardiograms. Linear regression was performed to assess the association between HIV serostatus and aortic diameters indexed for body surface area (BSA) at the aortic root and supravalvular levels, after adjusting for potential confounders. The multivariable model adjusted for age, race/ethnicity, MACS site, enrollment period (pre/post 2001), atherosclerotic risk factors (systolic blood pressure, medications to treat hypertension, smoking history, diabetes, total cholesterol level, high density lipoprotein level) and statin use. Results: We included 653 HIV+men (mean age 54.6 years, 47.8%white, 32.6% black, 16.8% diabetic, 13.0 pack-year smoking history) and 526 HIV- men (mean age 60.4 years, 69.0%white, 21.7% black, 11.8% diabetic, 12.5 pack-year smoking history). After adjusting for the aforementioned covariates and indexing for BSA, aortic root (p<0.01), sinotubular junction (p<0.01), and ascending aorta (p<0.001) were all significantly larger in HIV+ compared to HIV- men. There was no significant difference in aortic root annulus size (Table 1). Among HIV+men, indexed aortic root, sinotubular junction and ascending aorta were all significant smaller in men with nadir CD4 count >500 cells/ mm 3 compared to men with CD4 counts <200 cells/mm 3 prior to initiating antiretroviral therapy (p<0.05). Conclusion: To our knowledge this is the first study to demonstrate an independent association between HIV serostatus and ascending aortic dilatation, even after controlling for traditional cardiovascular risk factors, which may have implications for ongoing surveillance and management.

655 CARDIAC EVENTS IN HIV-INFECTED PATIENTS WHO USE TENOFOVIR ALAFENAMIDE (TAF) Brent Appelman 1 , Guido Van Den Berk 1 , Marieke De Regt 1 , Narda Van Der Meche 1 , Daoud Ait Moha 1 , Piter Oosterhof 1 , Joost Vanhommerig 1 , Kees Brinkman 1 1 OLVG, Amsterdam, Netherlands Background: Although cardiac events (CEs) were not reported as side effects of TAF in registration trials, we observed some new CEs in HIV positive patients who started TAF. We retrospectively studied all CEs in our HIV cohort, with special focus on the use of TAF compared to tenofovir disoproxil fumarate (TDF). Methods: All OLVG patients receiving cART between January 1st, 2016 and May 31st, 2018 were selected and allocated to 3 mutually exclusive groups according to cART component prior May 31st, 2018. Patients that used TAF (TAF), patients that used TDF but never used TAF (TDF) and patients without ever using a tenofovir cART (NT). The start date was registered as the first day of treatment with the group defining component of tenofovir; for the NT group this was the date of initial cART start. CEs were defined as myocardial infarction, cardiomyopathy, arrythmia or angina pectoris. CEs-free survival was estimated using Kaplan-Meier analysis. Hazard ratios (HR) for CEs were adjusted for previous cardiac history, BMI, gender, age per quartile and smoking using Cox regression analysis. Results: We included 2985 patients: 1170 in TDF, 1537 in TAF and 278 in NT. Median follow-up was 2.2 years (IQR: 1.4-2.6) for TAF, 7.0 years (IQR: 4.0-9.9) for TDF and 9.0 years (IQR: 3.5-17.0) for NT. In TDF 58(5.0%) CEs were reported, in TAF 43(2.8%) and in NT 11(4.0%). Cardiac history was more frequent in TAF vs. TDF, odds ratio: 1.9 (95% CI: 1.3-2.9; P=0.001). Kaplan-Meier analysis showed a significant difference between groups (figure 1; log-rank test: P<0.001). Unadjusted Cox regression showed an increased hazard for CEs in TAF vs. NT, HR: 7.0 (95% CI: 2.9-17.2; P<0.001) and in TAF vs. TDF, HR: 2.8 (95% CI: 1.6-5.0; P<0.001). After adjusting for covariates, the HR of CEs in TAF vs. NT decreased to 3.9 (95% CI: 1.5-9.8; P=0.005) and in TAF vs. TDF to 1.9 (95% CI: 1.0-3.6; P=0.034). Conclusion: The occurrence of CEs in TDF and in NT were significantly different compared to TAF. In contrast to registration trials, an older population with more cardiac history might explain our unexpected observation in this real-life cohort. Since follow-up of TAF was short and the rate of CEs low, confirmation of our observation in larger cohorts is necessary, to better advise about TAF use in elder patients with a history of CEs.

Poster Abstracts

654 PREVALENCE OF PULMONARY HYPERTENSION IN HIV-INFECTED PATIENTS AND REDUCED OUTCOME

Nico Reinsch 1 , Hendrik Streeck 2 , Meinhard Mende 3 , Till Neumann 4 , Norbert H. Brockmeyer 5 , Jan Kehrmann 2 , Dirk Schadendorf 2 , Stefan Esser 2 1 Alfried Krupp Hospital, Essen, Germany, 2 University of Duisburg-Essen, Essen, Germany, 3 University Leipzig, Leipzig, Germany, 4 University Hospital of Duisburg- Essen, Essen, Germany, 5 Ruhr-University Bochum, Bochum, Germany Background: The epidemiology and prognostic impact of increased pulmonary pressure among HIV-infected individuals in the antiretroviral therapy era is not well described. We therefore examined the prevalence and outcomes of increased echocardiographic pulmonary pressure in HIV-infected individuals. Methods: This study evaluated subjects from the HIV-HEART study. The HIV HEART study (HIVH) is an ongoing prospective observational cohort study in the German Ruhr Area starting in 2004 to assess the rate of cardiovascular disease (CVD). This longitudinal analysis included HIV+ patients with up to 12 years of follow-up. Echocardiography with reported pulmonary artery systolic pressure (PASP) and tricuspid annular plane systolic excursion (TAPSE) as sign of right heart dysfunction was obtained in almost all patients. Results: PASP was documented in 1064 subjects. The mean follow-up was 8.9 ±4.1 years. Pulmonary hypertension (PH) > 35mmHg was detected in 157/ 1064 patients (14.8%). Of these, 81 (51%) were asymptomatic and 76 (49%) patients presented with dyspnoe/ TAPSE < 20mm as a sign of right heart dysfunction. PASP was lower in patients without PH compared to patients with PASP > 35mmHg but without symptoms and patients with and PASP > 35mmHg and signs of right heart dysfunction (23 ±6.6 mmHg vs. 33.2 ±10.3 mmHg vs. 37 ±8.2 mmHg). Overall, 82 (8%) of patients with follow-up data had died. Mortality was associated with an increased functional impairment (Figure 1).

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